In 1986, Congress enacted EMTALA, as part of the Consolidated Omnibus Budget

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1 Program Sponsors: Children s Hospital of Wisconsin Froedtert Memorial Lutheran Hospital Illinois Helicopter Additional Sponsor: Centegra Northern llinois Medical Center FLIGHT ROUNDS Winter 2004 HOSPITAL HELIPADS AND THE EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA) Steve Andrews, MD, EMT-P Medical Director, Flight For Life In 1986, Congress enacted EMTALA, as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, to ensure public access to emergency services regardless of ability to pay. The original language of EMTALA left a lot of questions unanswered, including what obligations hospitals had regarding use of their helipads. A technical assistance document published in 2001 and EMTALA interpretive guidelines published in May 2004 have clarified the EMTALA obligations for hospital helipads. These two documents clearly state that hospitals with helipads do not have an EMTALA obligation to provide Medical Screening Exams (MSE) to patients who are using the helipad to get to another hospital, unless the EMS providers ask for their assistance. Below are the key excerpts. In 2001, the Texas Department of Health asked the Center for Medicare and Medicaid Services (CMS) the question, Q: Does the use of a hospital s helipad by an EMS provider rendezvousing with a medical helicopter place the hospital itself at risk for violating EMTALA guidelines? CMS answered, A: The use of a hospital s helipad to effectuate a field transfer of a patient does not trigger that hospital s EMTALA obligation. We consider that hospital to be functioning as part of the local EMS service and is, therefore, deemed in compliance. If hospital staff come out and do something to the patient on the helipad (open an airway, start an IV), then technically the EMTALA obligation is triggered, but we only require that you document that intervention and either send it with the patient or transmit the information to the receiving hospital. 1

2 2004 UPCOMING EVENTS/CONFERENCES TNS Course January 26 27, February 2, 3, 9, 10, 16, 17, Emergency Services Conference Flight For Life will host its 21st annual Emergency Services Conference: Trends and Issues 2005 in March and September. Dates TBA. PHTLS January 14 and 15, Provider class March 19 and 20, Provider class August 13, Refresher class October 8, Instructor class Safety Inservice The Wisconsin helicopter will offer a safety inservice August 20, The location of the inservice will be Froedtert Hospital. Upon completion of the inservice, personnel are eligible to sign up for a ride along shift with the Flight For Life staff. Participation in this program is open to pre-hospital personnel in the following counties: Dodge, Fond du Lac, Jefferson, Kenosha (north of Hwy 142), Milwaukee, Ozaukee, Racine, Sheboygan, Walworth, Washington, and Waukesha. Participation is also open to registered nurses working in emergency and critical care departments. To register, call Terry Hirsch at (414) Non-Profit Organization U.S. Postage PAID Permit No Milwaukee, WI Flight For Life A Program of the Milwaukee Regional Medical Center 9000 W. Wisconsin Avenue Milwaukee, Wisconsin 53226

3 (EMTALA cont d) In the CMS letter to State Survey Agency Directors Subject: Revised Emergency Medical Treatment and Labor Act (EMTALA) Interpretative Guidelines 2 published May 13, 2004, new guidelines were issued which included hospital helipads. The Interpretative Guidelines state, The following two circumstances will not trigger EMTALA: 3 If as part of the EMS protocol, EMS activates helicopter evacuation of an individual with a potential EMC 4, the hospital that has the helipad does not have an EMTALA obligation if they are not the recipient hospital, unless a request is made by EMS personnel, the individual, or a legally responsible person acting on the individual s behalf for the examination or treatment of an EMC. The use of a hospital s helipad by local ambulances or other hospitals for the transport of individuals to tertiary hospitals located throughout the State does not trigger an EMTALA obligation for the hospital that has the helipad on its property when the helipad is being used for the purpose of transit the hospital with the helipad is not obligated to perform another MSE prior to the individual s continued travel to the recipient hospital. If, however, while at the helipad, the individual s condition deteriorates, the hospital at which the helipad is located must provide another MSE and stabilizing treatment within its capacity if requested by medical personnel accompanying the individual. These documents clearly establish there is no EMTALA obligation for hospitals with helipads when those helipads are being used as transit points to other hospitals. Unfortunately, these documents have not been widely disseminated and are not easily found in the government database. Please share them with your risk managers, lawyers, and other concerned parties. (The article author added the bold lettering.) 1 Texas Department of Health Bureau of Emergency Management and Center for Medicare and Medicaid Services, Emergency Medical Treatment and Active Labor Act (EMTALA) and Trauma Diversions, Technical Assistance Document August 2001, page CMS letter to State Survey Agency Directors Subject: Revised Emergency Medical Treatment and Labor Act (EMTALA) Interpretative Guidelines published May 13, 2004, Ref: S&C State Operations Manual, Appendix V- Interpretive Guidelines- Responsibilities of Medicare Participating Hospitals in Emergency Cases published May 13, 2004: page EMC=Emergency Medical Condition Flight For Life Firsts Statistics on Flight For Life Air medical helicopter in Wisconsin Transported 282 patients its first year Dedicated 24-hour Fixed Wing Service in Wisconsin Patient transported on an Intra-Aortic Balloon Pump in Wisconsin Air medical program in Wisconsin to be accredited by CAMTS (Commission on Accreditation of Medical Transport Systems) Both helicopters and fixed wing transported 697 patients in 1987 By 1988, the program transported almost 3,000 patients total In 1997, FFL transported over 10,000 patients as a program Patient transported on a Bi-Vad and Intra-Aortic Balloon Pump in Wisconsin In 2000, the program transported its 15,000th patient In December of 2003, the program transported over 20,000 patients

4 Scene Call of the Year Award 2003 The 10th Annual Flight For Life Scene Call of the Year Awards were presented at four separate events in the spring/summer of 2004 to honor the winning departments The award was developed to recognize and honor the outstanding contributions to patient care by EMS professionals in northern Illinois and Wisconsin. On May 16th, Richmond Township and Spring Grove Fire Protection Districts received their 2003 Scene Call of the Year Award. The award was presented during a community Open House celebration that kicked off national EMS Week. This call was chosen as one of the winners due to the prolonged extrication and critical nature of the four patients, the additional requirement of east and west operational areas, and four helicopters being utilized for patient transport. The departments did an excellent job of scene coordination and safety while handling a very complex situation. The Hampshire Fire Protection District was presented theflight For Life-Northern Illinois Combination Department Scene Call of the Year Award for 2003 at their annual department dinner on Saturday, April 17th. The department received the award for a call that involved three semis, one minibus, a pickup truck, eighteen mutual aid departments, and three helicopters. There were eight fatalities and 16 patients transported. The large number of patients combined with the severity of their injuries and the multiple extrications made this a very difficult and challenging call. The North Shore Fire Department (NSFD) received one of the Wisconsin awards at their annual Recognition/Retirement banquet held on May 4, They responded to a minivan vs. truck collision, which caused multiple injuries to six victims in the minivan; several were still trapped. On-scene personnel quickly requested Flight For Life. The fire department coordinated rapid stabilization of all six patients, with the flight crew concentrating their efforts on two critically injured patients. This call was also unique because the flight nurse and flight physician elected to split up, each crewmember accompanied by a NSFD paramedic, to transport these two patients. One patient went by air and one by ground to Froedtert Hospital's Trauma Center, as they were both too unstable to be transported in one vehicle. Flight For Life-Wisconsin also recognized the Campbellsport Fire Department (CFD), presenting the second award at their monthly training meeting held at the fire house. They had called Flight For Life to the scene of a two vehicle crash involving a car and a full-sized suburban towing a 26-foot trailer. There were seven patients in the suburban and one patient unconscious and trapped in the car. CFD personnel worked creatively and cautiously to complete the extrication, which was complicated by 50-pound tanks of propane on the trailer. Flight For Life was landed about ½ mile from the crash. Upon the flight crew's arrival to the scene, the patient was just being loaded into the ambulance, where he was stabilized for transport back to the helicopter and ultimately, to the Trauma Center at Froedtert Hospital. These calls highlight the extraordinary teamwork among dispatchers, EMS, fire departments, law enforcement agencies, and air medical services as they exhibit expert management of available resources to provide the best possible patient outcomes. Congratulations to North Shore, Campbellsport, Richmond Township, Spring Grove Fire Protection District, and Hampshire Fire Protection District for a job well done!

5 FLIGHT FOR LIFE S 20TH ANNIVERSARY In The Beginning... Tammy Chatman Professional Relations/Marketing Manager Barbara Hess was the founder and director of the Flight For Life program. She along with Joseph Darin, MD, then Chairman of the Department of Emergency Medicine at the Medical College of Wisconsin, started Flight For Life in She waged a two-year battle with breast cancer but died of the disease on October 11, 1988, just one year after helping to start the Flight For Life-Northern Illinois helicopter in McHenry, IL. Barb and her accomplishments are honored on the cover of the 20th Anniversary edition of the 2004 Flight For Life calendar. Not only did she start the FFL- Wisconsin and FFL-Northern Illinois sites, she was responsible for beginning Flight For Life-International, which was a fixed wing service. Barb began her flight nursing career with Emery Air Charter. In 1981 she was named the Program Director for Lifeline Emergency Helicopter at St. Anthony Medical Center in Rockford, IL. Then, in January of 1984, she began Flight For Life-Wisconsin with a Bell 206 Long Ranger, a single engine helicopter. FFL-International followed in April of 1985 and then FFL-Northern Illinois in May of It was because of Barb s early vision and dedication that FFL has become the program that it is today, dedicated to the utmost in safety and patient care. She was a very determined person with a great sense of humor. Barb worked tirelessly introducing the helicopter and then the fixed wing from large cities like Chicago to small towns in Michigan. She visited former FFL patients and their families, in the hospital and at their homes, making them a part of the ever-expanding Flight For Life family. It was not just the success of Flight For Life that Barb worked so hard for, but the success of the air medical industry as well. She was an active member of the Association of Air Medical Services (AAMS) (formerly ASHBEAMS), serving as membership chairman and as a regional director. She was named to the National Dedicated Fixed Wing Air Ambulance Advisory Board in Barb and FFL hosted the national air medical conference in Milwaukee in 1987 as well. Several weeks before she died, Barb was recognized by her peers at the ASHBEAMS conference in Boston with the Marriott/Carlson Award. It is the industry s highest award and is given to the individual who has demonstrated long and dedicated service to the promotion of emergency air medical services. Scott Air Charter, then FFL-International s airplane vendor, flew Barb to Boston to accept her award. Today there is an award sponsored by Sikorsky Aircraft Corporation in Barb s name. The Barbara A. Hess Award is given to an individual who has significantly contributed to the enhancement, development, and/or promotion of the air medical community through their research and/or educational efforts. Flight For Life established the Barbara Hess Memorial Fund shortly after Barb s death. The Fund provides FFL crewmembers with monies to be used for additional educational opportunities that are not funded by the program. Any donations made to Flight For Life are placed into the Memorial Fund account, enabling present and future crewmembers to pursue their educational goals. Barb was the matriarch of the Flight For Life family. As her illness progressed, flight nurses regularly went to her apartment to assist in her care. Some, such as Claire Rayford, then FFL-Wisconsin Chief Flight Nurse, were there along with her mother and father when she died. It was Barb s wish to have her ashes spread over Lake Michigan from the helicopter. Members of the team honored her request but as the window was opened to allow the ashes to float out, some of them blew back into the aircraft. Claire said that Barb must have not wanted to go and so for as long as FFL flew that aircraft, a little part of Barb was along for the ride! Losing Barb was like losing one of your own family members, it took a long time to heal. The program will never replace Barb but the management of Flight For Life continues to move forward into the future, carrying with them her love and dedication for a program that has touched the lives of over 21,000 patients. Thank you Barb, from those of us who came after you, for making the dream of Flight For Life a reality.

6 Helicopter Landing Zone Safety Tips John Wescott and Don Kent Pilots, Flight For Life-Northern Illinois It has been said that take-offs are optional but all landings are mandatory. The ability to get into and out of the Landing Zone (LZ) safely is paramount for all of those on scene. Flight For Life depends on the ground crews to establish the LZ, provide a description of any hazards or obstructions, and secure the perimeter of the LZ until the helicopter has left the scene. We would like to offer you a few additional tips to keep in mind when setting up and securing an LZ, day or night. 8. Provide dispatch with location of the LZ that includes the closest major intersection. Just because we have landed there before, the pilot operating the helicopter may need more information. We hope that you find these tips useful and can integrate them into what you already do for us. We strongly encourage you to attend annual safety training and LZ set-up sessions. We depend on you to assist in getting us in and out safely. 1. Pick the biggest spot you can find but please don t be offended if the pilot picks out a bigger spot; only he/she knows if he can get in and out of the landing spot based on temperature, humidity, wind, fuel load, and weight. 2. Pick the most level spot you can find. The spot may look flat enough but may be too sloped to be considered safe. 3. All kinds of things can be hidden in darkness and the familiar can appear strange, even with artificial light. Be sure to scan the LZ and its periphery for obstructions; make sure to tell the pilot about them. Items such as boulders, stumps, holes, and tree limbs can be hidden in tall grasses/weeds. Make sure to walk the LZ looking for these haz ards which are especially difficult for the pilot and crew to see at night. 4. DO NOT SHINE LIGHTS AT THE HELICOPTER AT NIGHT (even after it has landed)! Doing this could compromise the pilot s night vision making it difficult to operate the helicopter. 5. Before communicating with an incoming helicopter, take a moment to orient yourself to north, south, east and west, to help minimize miscommunication of obstructions and/or hazards. 6. Don t forget to wear hearing and eye protection when working around a running helicopter. 7. No matter how comfortable you are around helicopters, never approach under the rotor blades of a running helicopter without verbal and/or visual permission from the pilot or flight crew.

7 Fun Facts: Air Medical Transport, Remembering the Beginning... Claire Rayford Professional Relations/Marketing Manager As Flight For Life continues to celebrate our 20th year of service, having transported over 21,000 patients, we thought you might enjoy reading a little bit about our roots. We include interesting facts about all modes of air transport but focus primarily on the use of rotor-wing aircraft for moving patients. It s fun to see how far we ve come in a relatively short time! 1783: Physicians were among the earliest aviators. French physician Pilatre de Rozier was the first person to fly in a Montgolfier balloon. 1870: It has often been erroneously reported that 160 wounded French soldiers were the first patients to be airlifted in hot air balloons during the Prussian Siege of Paris. The aeronaut s flight report actually lists numerous carrier pigeons, several dogs (uninjured), and 103 socially prominent citizens on this flight. 1903: The Wright brothers invented the first successful airplane. 1910: The American military first recommended transport of patients by airplane. 1915: Thought to be the first reported air medical transport, a French pilot evacuated a Serb in an unmodified fighter airplane. 1918: The first airplane patient transport occurred in the U.S., with the aircraft s open rear cockpit converted to accommodate a single litter patient. Medical access was impossible. WWII: Large military transport planes utilized by the Army Air Force completed over 1,000,000 patient transports. 1942: The helicopter was invented and perfected for flight. Korean War: First large-scale forward evacuation of wounded soldiers by helicopter, using Sikorsky S-51 and smaller Bell 47 aircraft fitted with outboard stretchers. The majority of the 20,000 casualty transports reached Mobile Army Surgical Hospitals (M.A.S.H. units) within one to five hours of injury. Vietnam War: The powerful UH-1H ( Huey ) helicopter transported hundreds of thousands of soldiers. In 1968, Operation Dustoff helicopters were evacuating 8,000 casualties per month, reducing the time between injuries to definitive care to only one hour. Mid-1960s: Civilian helicopter programs were introduced in West Germany and Switzerland, primarily prompted by growing concerns for the victims of motor vehicle crashes along the infamous autobahn system. These medical helicopters were the first civilian air ambulances and became part of a system of regional trauma care. 1969: One of the largest civilian applications of air medical transport began when Maryland s State Police Helicopter service was utilized as a dual-purpose law enforcement/patient evacuation system. There was a limited commitment to medical response, with a basic scoop and run - type service provided by a pilot and a law officer/emt crew. 1972: The first totally dedicated, hospital-based helicopter service was introduced in Denver at St. Anthony s Hospital. This did not occur as part of a regional trauma system, but in anticipation of the potential evacuation of injured skiers who were participating in the 72 Winter Olympics. This helicopter program was called Flight For Life and was our program s namesake. 1978: There were still fewer than 20 hospital-based rotor-wing programs in the United States. What originally had been predominantly a trauma-oriented focus of transport expanded to include neonatal, obstetric, and cardiac patients. Numbers of interfacility transports began to rise. 1984: Rapid proliferation of new air medical programs occurred. By the time Flight For Life was established as the first hospital-based service in Wisconsin, the total number of programs was 60. The industry also changed and expanded to include many programs adding more aircraft to their fleet as satellite operations. By the mid-1980s, over 100 programs existed nationwide. Currently over 300 hospital- and non-hospital-based programs blanket America from coast to coast, transporting thousands of patients annually.

8 Flight For Life Safety Crossword Puzzle Patty Mitchell and Bobby Olszewski Assistant Chief Flight Nurse and Flight Paramedic, Flight For Life-Northern Illinois